Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.09.010
Brazilian Journal of Anesthesiology
Scientific Article

Administration of paracetamol versus dipyrone by intravenous patient-controlled analgesia for postoperative pain relief in children after tonsillectomy

Administração de paracetamol versus dipirona em analgesia controlada pelo paciente por via intravenosa para alívio da dor no pós-operatório de crianças após tonsilectomia

Mesut Sener; Aysu Kocum; Esra Caliskan; Ismail Yilmaz; Fatma Caylakli; Anis Aribogan

http://dx.doi.org/10.1016/j.bjane.2013.09.010 Braz J Anesthesiol, vol.65, n6, p.476-482, 2015
PDF English
PDF Português
Downloads: 0
Views: 758

Abstract

BACKGROUND AND OBJECTIVE: We compared the efficacy of intravenous (IV) paracetamol versus dipyrone via patient-controlled analgesia (PCA) for postoperative pain relief in children. METHODS: The study was composed of 120 children who had undergone elective tonsillectomy after receiving general anesthesia. Patients were divided into 3 groups according to the dosage of postoperative intravenous-patient-controlled analgesia: paracetamol, dipyrone, or placebo. Pain was evaluated using a 0- to 100-mm visual analog scale and 1- to 4-pain relief score at 30 min, 1, 2, 4, 6, 12, and 24 h postoperatively. Pethidine (0.25 mg kg-1) was administered intravenously to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment related adverse effects were noted. RESULTS: Postoperative visual analog scale scores were significantly lower with paracetamol group compared with placebo group at 6 h (p < 0.05), dipyrone group compared with placebo group at 30 min and 6 h (p < 0.05). No significant differences regarding visual analog scale values at 1, 2, 4, 12, and 24 h were found. No significant differences were found between groups with respect to pain relief score (p > 0.05). Postoperative pethidine requirements were significantly lower with paracetamol and dipyrone groups compared with placebo group (62.5%, 68.4% vs 90%, p < 0.05). No significant differences were found between groups with respect to nausea, vomiting and the any other adverse effects of the drugs (p > 0.05). CONCLUSIONS: Paracetamol and dipyrone have well tolerability profile and effective analgesic properties when administered IV-PCA for postoperative analgesia in children after tonsillectomy.

Keywords

Analgesia, Patient-controlled, Pediatric, Pain, Postoperative, Tonsillectomy

Resumo

JUSTIFICATIVA E OBJETIVO: Comparamos a eficácia da administração de paracetamol versus dipirona em analgesia controlada pelo paciente (PCA) por via intravenosa (IV) para alívio da dor no período pós-operatório em crianças. MÉTODOS: O estudo foi composto por 120 crianças submetidas à tonsilectomia sob anestesia geral. Os pacientes foram divididos em três grupos de acordo com a dose IV de analgesia controlada pelo paciente no pós-operatório: paracetamol, dipirona ou placebo. A dor foi avaliada com uma escala visual analógica de 0-100 mm e escore de 1-4 para alívio da dor nos tempos de 30 minutos, uma, duas, quatro, seis, 12 e 24 horas de pós-operatório. Petidina (0,25 mg kg-1) foi administrada IV aos pacientes que precisaram de analgesia de resgate. A necessidade de petidina foi registrada durante as primeiras 24 horas de pós-operatório e os efeitos adversos relacionados ao tratamento foram registrados. RESULTADOS: Os escores da escala visual analógica no pós-operatório foram significativamente menores no grupo paracetamol em comparação com o grupo placebo em seis horas (p < 0,05) e no grupo dipirona em comparação com o grupo placebo em 30 minutos e seis horas (p < 0,05). Não houve diferença significativa em relação aos valores da escala visual analógica nos tempos avaliados de uma, duas, quatro, 12 e 24 horas. Não houve diferença significativa entre os grupos quanto ao escore de alívio da dor (p > 0,05). A necessidade de petidina foi significativamente menor nos grupos paracetamol e dipirona em comparação com o grupo placebo (62,5%, 68,4% vs. 90%, p < 0,05). Não houve diferença significativa entre os grupos em relação à incidência de náusea, vômito e outros efeitos adversos dos medicamentos (p > 0,05). CONCLUSÕES: Paracetamol e dipirona têm um perfil de boa tolerabilidade e propriedades analgésicas eficazes quando administrados IV para ACP no pós-operatório de crianças após tonsilectomia.

Palavras-chave

Analgesia, Controlada pelo paciente, Pediatria, Dor, Pós-operatório, Tonsilectomia

References

Walker SM. Pain in children: recent advances and ongoing chal- lenges. Br J Anaesth.. 2008;101:101-10.

Verghese ST, Hannallah RS. Acute pain management in children. J Pain Res.. 2010;15:105-23.

Uysal HY, Takmaz SA, Yaman F. The efficacy of intravenous paracetamol versus tramadol for postoperative analgesia after adenotonsillectomy in children. J Clin Anesth.. 2011;23:53-7.

Malaise O, Bruyere O, Reginster JY. Intravenous paracetamol: a review of efficacy and safety in therapeutic use. Future Neurol.. 2007;2:673-88.

Brodner G, Gogarten W, Van Aken H. Efficacy of intra- venous paracetamol compared to dipyrone and parecoxib for postoperative pain management after minor-to-intermediate surgery: a randomised, double-blind trial. Eur J Anaesthesiol.. 2011;28:125-32.

Henneberg SW, Nilson LB. Acute paediatric pain. Current Anaes- thesia & Critical Care.. 2007;18:126-34.

Penuelas˜- Acuna˜ J, Oriol -López SA, Hernández-Bernal CE. Ketorolac vs metamizol preemptive analgesia in children. Cir Cir.. 2003;71:50-4.

Sittl R, Griessinger N, Koppert W. Management of postop- erative pain in children. Schmerz.. 2000;14:333-9.

Levy M, Zylber-Katz E, Rosenkranz B. Clinical pharmacoki- netics of dipyrone and its metabolites. Clin Pharmacokinet.. 1995;28:216-34.

Messerer B, Gutmann A, Weinberg A. Implementtation of a standardized pain management in a pediatric surgery unit. Pediatr Surg Int.. 2010;26:879-89.

Schug SA, Manopas A. Update on the role of non-opioids for postoperative pain treatment. Best Pract Res Clin Anaesthesiol.. 2007;21:15-30.

Kampe S, Warm M, Landwehr S. Clinical equivalence of IV paracetamol compared to IV dipyrone for postoperative analgesia after surgery for breast cancer. Curr Med Res Opin.. 2006;22:1949-54.

Ohnesorge H, Bein B, Hanss R. Paracetamol versus metamizol in the treatment of postoperative pain after breast surgery: a randomized, controlled trial. Eur J Anaesthesiol.. 2009;26:648-53.

Morton NS, O'Brien K. Analgesic efficacy of paracetamol and diclofenac in children receiving PCA morphine. Br J Anaesth.. 1999;82:715-7.

Lawrie SC, Forbes DW, Akhtar TM. Patient-controlled anal- gesia in children. Anaesthesia.. 1990;45:1074-6.

Karaca M, Kocoglu H, Gocmen A. Comparison of lornoxicam with tramadol in patient-controlled analgesia after gynecolog- ical surgery. Eur J Gynaecol Oncol.. 2006;27:78-80.

Rodriguez MJ, Delatorre MR, Pereziraola P. Comparative study of tramadol versus NSAIDS as intravenous infusion for man- aging postoperative pain. Curr Ther Res.. 1993;54:375-83.

Sener M, Yilmazer C, Yilmaz I. Patient-controlled anal- gesia with lornoxicam vs. dipyrone for acute postoperative pain relief after septorhinoplasty: a prospective, randomized, double-blind, placebo-controlled study. Eur J Anaesthesiol.. 2008;25:177-82.

Torres LM, Rodriguez MJ, Montero A. Efficacy and safety of dipyrone versus tramadol in the management of pain after hysterectomy: a randomized, double-blind, multicenter study. Reg Anesth Pain Med.. 2001;26:118-24.

Stamer UM, Hothker F, Lehnen K. Postoperative analgesia with tramadol and metamizol. Continual infusion versus patient controlled analgesia. Anaesthesist.. 2003;52:33-41.

Torres LM, Collado F, Almarcha JM. Treatment of post- operative pain with intravenous PCA system. Comparison with morphine, metamizole, and buprenorphine. Rev Esp Anestesiol Reanim.. 1993;40:181-4.

Rose M. Systemic analgesics for children. Anaesthesia Intensive Care Med.. 2007;8:184-8.

Oscier CD, Milner QJW. Peri-operative use of paracetamol. Anes- thesia.. 2009;64:65-72.

Kehlet H, Werner MU. Role of paracetamol in the acute pain management. Drugs.. 2003;63:15-22 (Spec no 2).

Grundmann U, Wörnle C, Biedler A. The efficacy of the non-opioid analgesics parecoxib, paracetamol and metamizol for postoperative pain relief after lumbar microdiscectomy. Anesth Analg.. 2006;103:217-22.

Andrade SE, Martinez C, Walker AM. Comparative safety evaluation of non-narcotic analgesics. J Clin Epidemiol.. 1998;51:1357-65.

Sener M, Yilmazer C, Yilmaz I. Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a compari- son with diclofenac, ketoprofen and dipyrone. J Clin Anesth.. 2008;20:103-8.

Korkmaz Dilmen O, Tunali Y, Cakmakkaya OS. Efficacy of intravenous paracetamol, metamizol and lornoxicam on post- operative pain and morphine consumption after lumbar disc surgery. Eur J Anaesthesiol.. 2010;27:428-32.

Watcha MF, White PF. Postoperative nausea and vomi- ting. Its etiology, treatment, and prevention. Anesthesiology.. 1992;77:162-84.

Panarese A, Clarke RW, Yardley MP. Early post-operative mor- bidity following tonsillectomy in children: implications for day surgery. J Laryngol Otol.. 1999;113:1089-91.

Kermode J, Walker S, Webb I. Postoperative vomiting in chil- dren. Anaesth Intensive Care.. 1995;23:196-9.

5dcd9c720e8825cd56bf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections